Prediction of Surgical Outcomes by Image Defined Risk Factors in Children with Wilms' Tumor

Author(s): Niaz Nilave, Nahid Afsana Zaman, Sajida Nahid, Amirul Morshed , Shahnoor Islam

Introduction: Wilms’ tumor (WT) is one of the most common childhood abdominal malignancies. Imaging plays a central role in diagnosis, staging, and response evaluation and follows up of children with WT. The aim of this study is to evaluate Computed Tomography (CT)-based image defined risk factors according to Socie’te’ Internationale d’ Oncologie Pe’diatrique (SIOP) protocol in predicting surgical outcomes in children with WT. Methods: In this prospective observational study, 31 children with Wilms’ tumor attended in department of pediatric surgery, Dhaka Medical College from July 2020 to Jun 2022. Tumor size > 7cm, volume >550cm³, ratio of tumor and abdominal diameter > 0.5, presence of displacement of great vessels, vascular thrombus, contralateral extension of tumor found on contrast enhance computed tomography (CECT) considered as Image Defined Risk Factors positive (IDRFs +). After meeting the inclusion criteria, IDRFs (+) 20 children with unilateral localized WT (stage I, II and III) treated with SIOP protocol were included in this study. Children with Image Defined Risk Factors negative IDRFs (-), stage IV, Bi-lateral, Extra-renal & syndromic WT were excluded. After neoadjuvant chemotherapy (NACT) they were reassessed for IDRFs and classified as IDRFS (+) & IDRFS (-) group. Data on preoperative CECT were collected and relations with surgical risk factors were analyzed. Result: Out of 20 patients 9 were male and 11 were female with mean age 46.35 months, 8 (40%) were right sided and 12 (60%) were left sided. Surgical outcomes were assessed and found complete resection was possible 100% in both groups. Tumor spillage occurred 9.1% and 11.1%, operative time (mean) was 125.8 min and 77.5 min, blood loss (mean) occurred 8.85 ml/kg and 4.15 ml/kg, tumor weight (mean) was 833 (gm) and 275 (gm) in IDRF (+) and IDRF (-) group respectively and statistically found significant p-value <0.05. In this study subjects with poor surgical outcomes, 66.7% cases had positive contra-lateral extension whereas none of the study subjects with good surgical outcomes had positive contra-lateral extension. Conclusion: Image Defined Risk Factors according to SIOP protocol are good predictors for surgical outcomes in children with unilateral localized (stage I, II, III) Wilms’ tumor.